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The Blood Supply of the Large Intestine

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 Journal of Anatomy
J. Anat. (2010) 216, pp335–343 doi: 10.1111/j.1469-7580.2009.01199.x

The spatial arrangement of the human large intestinal

wall blood circulation
David Kachlik,1,2 Vaclav Baca1,2 and Josef Stingl1
1
Third Faculty of Medicine, Charles University in Prague, Ruská, Praha, Czech Republic
2
Department of Medicine and Humanities, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno,
Czech Republic

Abstract
The aim of the study was to describe and depict the spatial arrangement of the colon microcirculatory bed as a
whole. Various parts of the large intestine and terminal ileum were harvested from either cadaver or section
material or gained peroperatively. Samples were then injected with India ink or methylmetacrylate Mercox resin
for microdissection and corrosion casting for scanning electron microscopy. The results showed that extramural
vasa recta ramified to form the subserous plexus, some of them passing underneath the colon taeniae. Branches
of both short and long vasa recta merged in the colon wall, pierced the muscular layer and spread out as the
submucous plexus, which extended throughout the whole intestine without any interruption. The muscular
layer received blood via both the centrifugal branches of the submucous plexus and the minor branches sent
off by the subserous plexus. The mucosa was supplied by the mucous plexus, which sent capillaries into the
walls of intestinal glands. The hexagonal arrangement of the intestinal glands reflected their vascular bed. All
three presumptive critical points are only gross anatomical points of no physiological relevance in healthy indi-
viduals. Neither microscopic weak points nor regional differences were proven within the wall of the whole
large intestine. The corrosion casts showed a huge density of capillaries under the mucosa of the large intes-
tine. A regular hexagonal pattern of the vascular bed on the inner surface was revealed. No microvascular criti-
cal point proofs were confirmed and a correlation model to various pathological states was created.
Key words injection; large intestine; microcirculation; scanning electron microscopy.

(tela subserosa, subserous layer), muscular layer (tunica

Introduction
Together with the tunica mucosa, the microcirculatory bed
of the colon plays a central role in the absorptive, secretory
and protective functions of the colon. Capillary endothelial
cells have a low proliferative rate and long turnover time,
thus providing a relatively stable structure within most tis-
sues. The two principal functions of the colon appear to be
the storage of faeces before evacuation and high-capacity
water absorption (Standring, 2005; Kachlik, 2006; Kachlik &
Hoch, 2008).
As for the wall of the large intestine, it is composed of
five main concentric layers (some of them having several
sublayers), which are ordered according to their position
from the external surface to the lumen (Wolfram-Gabel
et al. 1986): serosa (tunica serosa, serous coat), subserosa
Correspondence
David Kachlik, Third Faculty of Medicine, Charles University in
Prague, Ruská 87, Praha 10, 10000, Czech Republic.
T: +420267102508; F: +420267102504; E: david.kachlik@lf3.cuni.cz
Accepted for publication 13 November 2009
muscularis, muscular coat), submucosa (tela submucosa)
and mucosa (tunica mucosa, mucous membrane). The mus-
cular layer is composed of two layers: longitudinal layer
(stratum longitudinale), reduced in the taenia coli (except
in the vermiform appendix and rectum), and circular layer
(stratum circulare). The mucosa is divided into three parts:
muscularis mucosae (lamina muscularis mucosae), propria
mucosae (lamina propria mucosae) and epithelium.
A thorough and detailed study summarizing the arrange-
ment of the microcirculatory bed in all layers of the large
intestine using injection methods on both the macroscopic
and microscopic level has not yet been performed.
Thus, the aim of the study was to describe the microcircu-
lation in the wall of the large intestine in detail by the use
of several methods. For study at the macroscopic level, India
ink injection was used, whereas at the microscopic level,
corrosion casting and histomorphology were applied. Par-
ticular attention was paid to the terminology of the
branches and plexuses. A model of the arrangement of the
blood vessels in the normal (healthy) large intestine was cre-
ated for possible comparison with pathological states, e.g.
Crohn’s disease, ulcerative colitis, colorectal cancer, etc.

ª 2010 The Authors

Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
336 Spatial arrangement of colon wall circulation, D. Kachlik et al.

Materials and methods

Two types of material were used in the study. A total of 142
samples were gathered from 118 cadavers (51 women and 67
men, aged 23–91 years) at the Department of Pathology of the
Third Faculty of Medicine, Charles University in Prague and at
the Královské Vinohrady Faculty Hospital in Prague. Another 21
samples were harvested during the operations of 20 patients (14
women and 6 men, aged 18–67 years) at the Department of Sur-
gery of both affiliations.
Wedge-shaped specimens were cut out equally from all seg-
ments of the large intestine. Each specimen included a 10–15-
cm section of the intestine with the mesocolon and supplying
blood vessels. The source vessel was dissected, incised and cann-
ulated, rinsed with saline (20–25 C) and injected. Two injection
media were used to replace the transparent saline.
1 A solution of black India ink (in a ratio of 2 : 3 with distilled
water, at 20–25 C) was successively injected into the vessel by Fig. 1 The corrosion cast of the vascular bed of the transverse colon
means of hand-controlled pressure. After ligation of the supplying and mesocolon with the Drummond’s marginal artery (arteria
blood vessels, the sample was immersed in an 8% formaldehyde marginalis coli). Bar: 2 cm. AM, arteria marginalis coli; aa, arterial
solution to be fixed for at least 10 days. After fixation it was arcade; vC, vasa centralia; vRL, vasa recta longa.
dissected under a Nikon SMZ-U preparation magnifying glass.
2 A commercial product of the synthetic methylmetacrylate resin, course, branching and relation to the neighbouring
Mercox C1-2B or Mercox C1-2R (Ladd Research, Burlington, VA, structures.
USA). A mixture containing 4 mL of prepolymerized resin and
1 mL of the monomer of methylmetacrylic acid containing
Straight vessels of the large intestine (vasa recta
62.5 mg of the methylmetacrylate paste as an accelerator was
intestini crassi)
made in the syringe and injected. Following injection and the
polymerization of Mercox, a 7.5% solution of potassium The vasa recta are branches from the Drummond’s marginal
hydroxide or 16% solution of nitric acid was used as macerating artery (arteria marginalis coli) or from the most peripheral
agent. The final corrosion cast was blue (if using the potassium (i.e. last) arcades of the colic arteries (see Fig. 1). Running
lye maceration), yellow (if using the blue Mercox and the nitric straight to the intestinal wall, they abruptly change their
acid maceration) or red (if using the red Mercox and the nitric direction when entering the serosa. Within the outermost
acid maceration). layer of the large intestine wall their branches form a fine
Afterwards, 51 samples of the large intestine were studied by intermingled net called the subserous plexus, which is the
scanning electron microscope (SEM). They were sputtered with only contribution of the vasa recta to the vascularization of
gold powder in the 11HD Polaron Series (sputter coater). In the the intestinal wall proper.
SEM, voltages of 2.5 and 10 kV were applied under magnifica-
There are rich anastomoses between individual vessels on
tions of 4–396 to scan the samples (Phillips ESEM XL30 with
both surfaces of the large intestine and no regional differ-
Cambridge Stereoscan 250). For details of the method, see Ahar-
inejad et al. (1992), Kachlik (2006) and Kachlik & Hoch (2008). ences are featured. They are arranged in a loose network of
The terminology used to describe the branches and plexus are transverse meshes bordered by mildly tortuous arteries.
based on the Terminologia Anatomica; the terms are stated in
English and then in Latin (in brackets using italics) (FCAT 1998).
Subserous plexus (plexus subserosus)
Synonyms: subserous arteries and veins (arteriae subserosae
Ethical considerations
et venae subserosae).
The study was approved by the Ethics Commission of the The vasa recta send frequent collaterals along their way,
Third Faculty of Medicine, Charles University in Prague. All starting at their origin from the marginal artery to their ter-
of the samples were harvested with the written informed mination. Before entering the external muscle layer, the
consent of the patients. short vasa recta give off branches to the mesocolic border
of the large intestinal wall. These branches are scattered
like the rays of a star but their short course limits the extent
Results
to which they can supply the intestinal wall. The short vasa
The blood vessels in the wall of the large intestine can recta only supply the area bordering the attachment of the
be divided into the vasa recta, subserous plexus, submu- mesocolon to the intestinal wall.
cous plexus, intermuscular plexus and mucous plexus. The long vasa recta have a characteristic slightly sinuous
Each of them can be described according to its origin, or sinusoid course in the subserous layer. On approaching

ª 2010 The Authors

Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
 Spatial arrangement of colon wall circulation, D. Kachlik et al. 337

the antimesocolic border, they can take an oblique or paral-

lel turn to the intestinal wall or even change direction and VRL

turn back to the mesocolic border. There are rich anastomo-

ses between the long vasa recta, short vasa recta and also
between both types of vessels. There are also anastomoses Ss
between their collateral and terminal branches at the meso-
colic and antimesocolic borders regardless of their localiza-
tion. Their average diameter is approximately 80 lm.
The vessels supplying the mesocolic border and mesocolic
taenia are branches of the short vasa recta. In addition,
there are branches of the long vasa recta or their collaterals
TL
supplying the anterior and posterior surface without any
penetration into the intestinal wall. Finally, there are
3 mm
branches for the distant omental taenia and free taenia,
which are derived from the terminal branches of the long
vasa recta before their penetrating into the intestinal wall. Fig. 2 The long vasa recta longa of the transverse colon submerging
The length of the subserous arteries does not exceed 8 mm, under the free taenia. India ink injection. Bar: 3 mm. Ss, plexus
usually varying between 2 and 4 mm. The subserous arteries subserosus; VRL, vasa recta longa; TL, taenia libera.
always terminate in the same manner. As they approach
any taenia or intestinal border, they bifurcate into a left
and a right branch of equal calibre (30–40 lm) taking a
course parallel to the longitudinal axis of the intestine.
Furthermore, in addition to the above-described branches,
there are muscular and omental branches that are derived
from the vasa recta, their collaterals or anastomoses. The
muscular branches change their direction after a short sub-
serous course, penetrating into the muscular layer (calibre:
30 lm). The branches for the greater omentum run perpen-
dicularly to the longitudinal axis of the intestine and leave
the intestinal wall via the omental taenia.
The subserous plexus sends minor branches to feed the
muscular layer of the intestine. They can be classified as
long and short branches, and are advised to be called long
and short muscular branches (rami musculares longi et bre-
ves). The short branches enter the external (longitudinal)
layer, arranged in the taeniae, and supply it, reaching as Fig. 3 The overview of the vascular bed of the large intestine in the
deep as the intermuscular space. The long branches pass scanning electron microscope. Corrosion cast. Bar: 2 mm. Mc, tunica
through the taeniae and send off branches to feed it. They mucosa; Sm, tunica submucosa; Ms, tunica muscularis.
continue and join or pass the intermuscular plexus and
finally terminate in the internal (circular) muscular layer. In recurrentes) and centripetal move in the direction of the
rare cases, they may reach the submucous plexus. This intestinal lumen and give rise to the mucous plexus. In com-
source of the arterial blood supply for the muscular layer is parison with the other layers of the intestinal wall, the sub-
to be considered of minor importance (see Figs 2–6). mucosa is rather thin (< 100 lm).
The feeding vessels are the long vasa recta. After their
extramural course they turn abruptly and penetrate the
Submucous plexus (plexus submucosus)
whole muscular layer perpendicularly to the longitudinal
The submucous plexus is situated within the submucosa axis of the intestine to reach the submucous plexus. Some
among the loose connective tissue, lymph vessels and ner- branches from the subserous plexus (long muscular
vous submucous plexus of Meissner. The vascular network is branches) may rarely reach the submucous plexus but their
composed of vessels of a large calibre running parallel to contribution to the plexus is negligible.
the longitudinal axis of the intestine. This plexus sends off The centrifugal branches can be divided into several types
branches for the terminal vascularization of the inner layers of arteries depending on their length, branching and termi-
of the intestinal wall. The outgoing vessels follow two nation. The centripetal branches are sent off perpendicu-
opposite directions – centrifugal turn back to the muscular larly to the longitudinal axis of the intestine and run
layer (called recurrent muscular branches; rami musculares directly to the lumen (see Figs 3, 4, 6, 7 and 8).

ª 2010 The Authors

Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
338 Spatial arrangement of colon wall circulation, D. Kachlik et al.
Fig. 4 The cross-section of the vascular bed of the large intestine in
the scanning electron microscope. Corrosion cast. Bar: 200 lm. Mu,
tunica mucosa; Sm, tunica submucosa; Ms, tunica muscularis; Ss,
plexus subserosus; aR, arteria recta; vR, vena recta.
Fig. 5 The external view of the surface of the vascular bed of the
large intestine in the scanning electron microscope. Corrosion cast.
Bar: 2 mm. VR1, VR2, adjacent vasa recta.
Intermuscular plexus (plexus intermuscularis)
Synonyms: plexus muscularis, plexus myentericus.
There is a greater number of feeding vessels that serve as
a source for the muscular layer; they are issued by the sub-
mucous plexus as its centrifugal branches, by the subserous
plexus as centripetal branches or emerge directly from the
penetrating vasa recta.
The centrifugal branches from the submucous plexus are
the most important source of arterial blood for the muscu-
lar layer of the intestinal wall. They are called the recurrent
muscular branches (rami musculares recurrentes plexus sub-
mucosi). They originate in the submucous layer from trunks
of the vasa recta, their collaterals or from mutual anastomo-
ses. Their diameter ranges from 25 to 30 lm.
Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
Fig. 6 The scheme of the intramural plexuses in cross-section of the
large intestine wall (freely according to Wolfram-Gabel). MT,
mesocolon transversum; LGC, ligamentum gastrocolicum; TM, tunica
mucosa; TSM, tunica submucosa; SC, stratum circulare; SL, stratum
longitudinale; OM, omentum majus; AO, appendix omentalis, ARL,
arteria recta longa; ARB, arteria recta brevis; PIM, plexus
intermuscularis; PSM, plexus submucosus; PM, plexus mucosus; PSS,
plexus subserosus.
Fig. 7 The longitudinal section of the vascular bed of the large
intestine in the scanning electron microscope. Corrosion cast. Bar:
500 lm. Mu, tunica mucosa; SM, tunica submucosa; C, glandulae
intestinales = Lieberkühn’s crypts; a, artefacts (extravasates).
According to their length, they can be classified as long,
middle and short. The short recurrent muscular branches
(rami musculares recurrentes breves) terminate exclusively
in the internal (circular) muscular layer without reaching
the intermuscular plexus. They are very short, ranging from
250 to 500 lm. The middle branches (rami musculares recur-
rentes medii) supply the internal (circular) muscular layer
and the intermuscularis plexus, which runs in a perpendicu-
ª 2010 The Authors

Fig. 8 The detail of the longitudinal section of the vascular bed of the
large intestine in the scanning electron microscope. Corrosion cast.
Bar: 200 lm. Mu, tunica mucosa; Sm, tunica submucosa; C,
glandulae intestinales = Lieberkühn’s crypts; a, artefacts (extravasate).
lar and rectilinear direction through the circular muscle
layer (750–1000 lm). They terminate in the intermuscular
plexus, which is parallel to the longitudinal axis of the intes-
tine. Finally, the long branches (rami musculares recurrentes
longi) have the same orientation as the middle branches
but reach as far as the muscular bundles of the taeniae
(longitudinal muscular layer). Some may even join the sub-
serous plexus. During their course, they send off branches
for both muscular layers and for the intermuscular plexus,
their length ranging from 1500 to 2000 lm. There are fre-
quent anastomoses between collateral and terminal
branches of all types of the recurrent muscular branches.
The second source of the arterial blood vessels, although
less numerous in branches and less voluminous, is provided
by arteries issued centripetally from the subserous plexus
(rami musculares plexus subserosi). These can be classified
as long and muscular branches. They originate from either
the vasa recta or from their collaterals and anastomoses.
Although not as significant as the recurrent muscular
branches from the submucous plexus, these branches con-
tribute considerably to the arterial blood supply of all three
taeniae. Their diameter is approximately 25 lm.
The short muscular branches enter the taeniae (longitudi-
nal muscular layer) running perpendicularly to the longitu-
dinal axis of the intestine and supply them. Some terminal
branches reach the intermuscularis plexus, being 200 lm
long (or 400 lm via the taenia) and helping to feed it. The
long muscular branches pass through the longitudinal mus-
cular layer and send off some nourishing branches. They
then join or pass the intermuscular plexus within the inter-
muscular space and terminate in the circular muscular layer.
Their length is usually between 750 and 1500 lm. In rare
cases, they may even reach the submucous plexus and con-
tribute to its blood supply.
ª 2010 The Authors
Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
Spatial arrangement of colon wall circulation, D. Kachlik et al. 339
The branches derived from this plexus and from all vessels
passing the muscular layer are called the interfascicular
branches (rami interfasciculares). Their diameter ranges
from 10 to 20 lm and they run rectilinearly between the
muscle fascicles which they supply. There are rich mutual
anastomoses. Finally, they send the fascicular branches
(rami fasciculares), which are 10–15 lm in diameter, into
the muscle fascicles perpendicularly to their longitudinal
axis. Their terminal branches are the precapillary arterioles
anastomosing with each other and forming a terminal arte-
riolar network giving rise to the capillary bed of the muscu-
lar fascicle (see Figs 3, 4 and 6).
Mucous plexus (plexus mucosus)
The entire thickness of the mucosa is regularly juxtaposed
by intestinal glands (glandulae intestinales; Lieberkühn’s
crypts). The upper ends of the glands open into the intesti-
nal lumen and the bases reach as deep as the muscularis
mucosae. The mucous plexus resembles a mosaic because of
its regular dimensions and shape. The diameter of its vessels
ranges from 25 to 30 lm. The mucous plexus is fed by the
mucosal branches from the submucous plexus. They run
perpendicularly to the longitudinal axis of the intestine.
Due to the presence of folds on the mucosal surface, their
course is variable and they can be classified as long and
short (see Figs 6–8).
The short mucous branches (rami mucosi breves) run to
the segments of mucosa located between two semilunar
folds. They originate from the adjacent submucous plexus
and send off two to four collateral branches. Their length
ranges from 500 to 1000 lm. The long mucous branches
(rami mucosi longi) run in the mucosa of the semilunar
folds. Their course is more rectilinear and sometimes slightly
flexed. The long mucous branches range in length from 2
to 5 mm. Each branch bifurcates at a variable distance from
the lumen into two branches of the first order (15 lm in
diameter). These branches then send off two or three more
branches of second order, respectively. All of these collater-
als successively send the precapillary arterioles (10 lm in
diamater). The arterioles coil round the bases and bodies of
the intestinal glands and descend as far as the furthermost
luminal surface. Some of the arterioles run a straight course
but the majority form waves and intermingle with each
other, sending off capillaries. A dense network of capillaries
covers the glands, which are embedded in a vascular cush-
ion (see Fig. 8).
The luminal surface is covered by capillaries. They change
their direction from perpendicular to horizontal and then
they turn back and run deep to join a venule. They may also
curve along the circular opening brim of the gland orifice,
encircling it like rods of a wreath (see Fig. 9).
The wreath-like structures are formed by one to five cap-
illaries and have various widths. The capillaries anastomose
with each other to encircle the circumference of the gland
340 Spatial arrangement of colon wall circulation, D. Kachlik et al.
Fig. 9 The overview of the vascular bed luminal surface of the large
intestine in the scanning electron microscope. Corrosion cast.
Capillaries encircling the luminal orifice of the glandulae intestinales.
Bar: 100 lm. Feeding capillaries enwrap the walls and encircle the
luminal gland orifice.
Fig. 10 The overview of the vascular bed luminal surface of the large
intestine in the scanning electron microscope. Corrosion cast. Bar:
200 lm. Hexagons of the bee honeycomb arrangement of glandulae
intestinales.
orifice. The length of each individual capillary is different,
ranging from a narrow spot, enabling the capillary to
change the ascending course into the descending course, to
one-half of the gland orifice circumference (see Fig. 10).
Some capillaries connect adjacent wreathes of vessels, usu-
ally in more anastomosing sites. This mosaic (carpet) is iden-
tical to the SEM picture of the normally-shaped intestinal
mucosa. The outline of the glands is maintained mainly by
the dense network of the superficially laid capillaries form-
Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
Fig. 11 The luminal orifices of the glandulae intestinales (Lieberkühn’s
crypts) of the vascular bed of the large intestine. Corrosion cast. Bar:
50 lm.
ing a system of vascular wreaths mutually connected and
merging to form a carpet. The diameter of the gland orifice
varies from 60 to 90 lm and the depth of the gland ranges
from 250 to 300 lm.
The total view of the gland carpet may resemble a honey-
comb (see Fig. 8). The gland orifices are arranged in a hex-
agonal web; the centre of one gland orifice is situated in
the middle of a hexagon and the corners are located in the
orifices of six adjacent glands (see Fig. 11). This strictly regu-
lar disposition organization of the intestinal gland reflects
the arrangement of the large intestine mucosa. The total
width of the mucous plexus varies from 200 to 300 lm.
Discussion
Resin corrosion injections are the most suitable technique
to depict and study the arrangement of blood vessels in the
intestinal wall at both the macroscopic and microscopic
level (Shikata & Shida, 1985; Christofferson & Nilsson, 1988;
Krstić, 1991; Aharinejad et al. 1992; Hossler, 1998). Our stud-
ies confirm this. As for the microcirculatory bed of the wall
of the large intestine, there are several studies reporting
the successful application of this technique in animals
(Shikata & Shida, 1985; Browning & Gannon, 1986; Christ-
offerson & Nilsson, 1988; Krstić, 1991; Aharinejad et al.
1992; Skinner et al. 1995; Hossler, 1998; Sangiorgi et al.
2007) but only few articles concerning the application in
humans (Gannon et al. 1984; Sun et al. 1992; Skinner et al.
1995; Araki et al. 1996; Fait et al. 1998). In animals, the prin-
cipal study was published by Shikata & Shida (1985). They
applied this technique in the experimental study of colon
anastomosis in healing after the stapler operation using
instruments of various origins in dogs. Gannon et al. (1984)
carried out an experiment involving vascular injections fol-
lowed by in-vivo microscopy of the laboratory rat large
ª 2010 The Authors

intestine. Details of the morphological relationship of indi-
vidual plexuses to the corresponding intestinal wall layers
and the level of their location were reported by Bernardes
& Patrı́cio (2004), Boulter & Parks (1960), Goerttler (1932),
Horstmann (1943), Ohtsuka et al. (1988), Wolfram-Gabel &
Maillot (1981) and Wolfram-Gabel et al. (1982, 1983, 1984,
1986). To compare the data of various segments of the gas-
trointestinal tube, see studies by Wolfram-Gabel et al.
(1984, 1986); the duodenum was scrutinized by Szyika
(1976) and Wolfram-Gabel et al. (1982), and the small intes-
tine and stomach by Barclay & Bentley (1949).
The vascular bed of the large intestine, as described
above, resembles a similar arrangement of the intramural
arteries in the stomach (Barclay & Bentley, 1949; Gannon
et al. 1984) and small intestine (Szyika, 1976). It also reflects
the vascular arrangement in the striated muscle, which was
described by Saunders et al. (1957) as ‘macromesh’ with a
finer plexus within it called the ‘micromesh’. In the large
intestine, the term ‘micromesh’ can be applied to the
mucous plexus between the epithelium of the mucosa and
the submucosa. The rich mucous vascular bed was termed
the ‘carpet’ by Brockis & Moffat (1958) who discovered the
similarity of the loops around the intestinal glands with the
carpet pattern.
As for the terminology, we followed the terms proposed
by Wolfram-Gabel & Maillot (1981) and Wolfram-Gabel
et al. (1982, 1983, 1984, 1986) and added the Latin terms to
all of the branches and plexus described (in brackets using
italics) because the Terminologia Anatomica (1998) and
Terminologia Histologica (2007) do not include any terms
concerning the microcirculatory bed of the intestine (FCAT
1998; FICAT, 2008).
As early as 1736, Albinus described the branching of the
intramural vessels in the intestinal wall but his study was
limited to the small intestine. This was proven by the trans-
lation of his thesis (Albinus, 1736; Kachlik, 2006; Kachlik &
Hoch, 2008). Bourgery (1839) described the subserous plexus
as the principal plexus issuing arteries for the deeper layers
of the intestinal wall. Mellière (1927) assumed the vasa
recta to be branches from the marginal artery, opening out
in the subserous connective tissue into a plexus nourishing
all deeper layers.
There is extensive branching of the subserous arteries,
especially in anastomotic branches that are rich in the subs-
erous layer and can be divided into anastomoses of the first
and second order, respectively. The first-order anastomoses
are situated either between two collateral branches,
between two terminal branches or between the collateral
and terminal branch of the adjacent vasa recta. Their diam-
eter is approximately 50 lm and they are arranged in a reg-
ular network with distances between adjacent vessels from
1.4 to 2.0 mm. This creates an impression of the continuous
and regular striation. The second-order anastomoses (being
of the same dimensions) are branches of the previous level
of anastomoses, situated mostly transversely and perpendic-
ª 2010 The Authors
Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
Spatial arrangement of colon wall circulation, D. Kachlik et al. 341
ularly to the longitudinal axis of the intestine, thus forming
the second striation. Such an arrangement, first described
in detail by Wolfram-Gabel et al. (1984), resembles that
reported by Szyika (1976) in the jejunum and ileum. Apart
from nourishing the subserous layer, the main purpose of
the vasa recta is to penetrate the muscular layer. There are
several terminal branches penetrating deep into the wall to
the submucous layer (Griffiths, 1961 reported four main
sites without any detailed data).
Ernst (1851) observed that the long vasa recta penetrat-
ing the muscular layer send off branches supplying it. Later,
Heller (1872) added the description of the blood supply of
the muscular layer directly from the subserous plexus (for
more details, see Hou-Jensen, 1931 and Wolf-Heidegger,
1942). The intermuscular plexus itself is interposed between
the internal (circular) and external (longitudinal) muscular
layers (arranged in the taeniae in the majority of the large
intestine) in the intermuscular space. It is rather thin but it
supplies the thickest layer of the large intestinal wall. This is
the reason why there are accessory vessels directly derived
from the adjacent plexuses (subserous and submucous).
These vessels contribute to the supply of the muscle bundles
and fibres without interpolating in any further plexus. The
plexus helps to hold both muscular layers in place. The long
recurrent muscular branches have the same course as the
middle branches but reach as far as the longitudinal muscu-
lar layer (taeniae). Some even join the subserous plexus, as
stated by Wolfram-Gabel et al. (1984). The second source of
the arterial blood vessels, although less frequent in
branches and less voluminous, is provided by arteries issued
by the subserous plexus centripetally. Wolfram-Gabel et al.
(1984) called them the ‘arteriae musculares’ but we recom-
mend the term muscular branches from subserous plexus
(rami musculares plexus subserosi). As for the mucous
plexus, our results of the diameter of the intestinal gland
orifices (varying from 60 to 90 lm) are similar to those
reported by Wolfram-Gabel et al. (1983) (80–100 lm).
Al-Fallouji (1984) was the first to emphasize that there
are no regional differences in the arrangement of the intra-
mural plexuses of the large intestine. Any segment of the
large intestine can be used as the terminal end for a postre-
section anastomosis. There is no morphological background
for the development of ischaemic consequences after the
anastomosis of two segments of the large intestine follow-
ing resection. Rather, the factors of primary importance
include: the calibre of the colon lumen, width of the colon
wall and the mobility of the colon segment. The danger of
ischaemia is due to the extensive traction of the mesocolon
or the newly anastomosed large intestine.
The existence of the continuous intramural plexuses
within the whole length of the small and large intestine
allows us to confirm the theory of a compact intestinal intra-
mural vascular canal. Such a connection is like one huge
anastomosis that can replace the blood supply of one source
artery if some disruption in flow occurs. A blockage due to
342 Spatial arrangement of colon wall circulation, D. Kachlik et al.
either iatrogenic (ligation) or pathological (embolization,
thrombosis, obturation or arteriosclerosis) causes can be
compensated in varying degrees by the anastomoses, which
allow a change in the direction of blood flow. Especially in
the rectum, the theory of the inverted blood flow from the
middle and inferior rectal artery to the network of the supe-
rior rectal artery, and even more orally, was suggested by
McGregor (1957) and Sunderland (1942). This theory is piv-
otal for the denial of the physiological function of the critical
points. These points exist as places of the interrupted blood
supply. In certain cases, the macroscopically visible anasto-
moses may be absent. In the otherwise healthy and unaf-
fected patient, they have no physiological function.
However, in cases of any pathological affliction or embryo-
logical discrepancy [e.g. in infant necrotizing colitis, arterio-
sclerosis (abdominal angina), venous thrombosis and states
with disrupted haemocoagulation], these points indicate
predisposed sites of vulnerability.
The architecture of the capillary network in the large
intestine segments was qualitatively described by Aharine-
jad & Lametschwandtner (1992) in rats and guinea pigs, by
Browning & Gannon (1986), Sangiorgi et al. (2007) and
Skinner et al. (1995) in rats, and in humans only by Sun
et al. (1992) in normal tissue, transitional mucosa and ade-
nocarcinoma, by Skinner et al. (1995) comparing rat and
human colon and by Araki et al. (1996) and Fait et al.
(1998). Interestingly, comparisons to the microvascular
architecture of the small intestine revealed some differ-
ences. Skinner et al. (1995) presented different types of
microvascular architecture within the individual villi. He dis-
cerned a fountain-like arrangement, in which the arterioles
reach the top of the villus without branching (‘fountain-
type’), a deeply interconnected type (‘step ladder’) and a
‘tuft-type’. Unfortunately, this classification cannot be
applied to the large intestine. Browning & Gannon (1986)
described a gradual reduction of both the mucous capillary
density and of the average network width towards the
aboral end of the large intestine. Aharinejad & Lametschw-
andtner (1992) perceived it as a reflection of successive
decrease of the water reabsorption towards the aboral end
of the colon. These findings are in stark contrast to the
results stated by Fait et al. (1998) and those obtained by us.
He suggested that the discrepancy between species is based
on different intestinal functions and nutrition. The rodent
colon is comparatively much longer than that of the
human. Fait et al. (1998) was the first to give a quantitative
description of a microvascular unit based on three parame-
ters: intercapillary distances (107.2 ± 27.6 lm), interbran-
ching distances (51.3 ± 28.5 lm) and branching angles
(87.4 ± 29.2) in various segments of the large intestine. He
found no regional differences. However, Araki et al. (1996)
reported several differences in microvascular architecture
between the ascending and sigmoid colon. The subsurface
capillary network of the ascending colon is honeycomb-
shaped and multi-layered, whereas that of the sigmoid
Journal compilation ª 2010 Anatomical Society of Great Britain and Ireland
colon is almost single-layered. He speculated that the capil-
lary network of the ascending colon is closely related to the
greater degree of water absorption and electrolyte trans-
port activities compared with those of the sigmoid colon.
Concluding remarks
This article brings together thorough and comprehensive
information on the arrangement of the blood supply to the
large intestine wall. All vascular plexuses are connected in a
long channel running through the whole length of the
intestine. If necessary, it can serve as a huge collateral. This
collateral is sufficient only in an otherwise non-afflicted
intestine (without developmental defect, immune, vascular
or connective tissue diseases, etc.). It presents a model that
can serve as a background for other studies concerning the
changes of the large intestine wall blood supply in various
pathological states, such as colorectal cancer, inflammatory
bowel disease, especially Crohn’s disease, etc.
Acknowledgements
Grant support: GAUK 108 ⁄ 1999 ⁄ C, GAUK 25 ⁄ 2001 ⁄ C and GAUK
103 ⁄ 2004 ⁄ C. Special thanks to Prof. Alois Lametschwandtner
(Department of Organismic Biology, Vascular and Muscle
Research Unit, University of Salzburg, Austria) for the use of the
SEM laboratory.
Author contributions
D.K. – substantial contributions to the conception and design,
performance of the injections, corrosion casting, acquisition of
data or analysis and interpretation of data. V.B. – substantial
contributions to the conception and design, performance of the
injections, corrosion casting, acquisition of data or analysis and
interpretation of data. J.S. – senior author, final approval of the
article.
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